REMAP-BP-HIV: REmote Blood Pressure Monitoring and Pharmacist-Led Telehealth Program among People Living with HIV. - SUMMARY/ABSTRACT Hypertension (HTN), defined as blood pressure (BP) ≥130/80 mmHg or use of antihypertensive medications, is the most prevalent modifiable risk factor for cardiovascular disease (CVD) among people living with HIV (PWH). Despite routine engagement in HIV care, BP control remains suboptimal, with fewer than half of PWH achieving BP control. This gap contributes to a growing burden of CVD, now a leading cause of morbidity and mortality in this population. HIV clinics are often the primary healthcare contact for PWH, yet structured HTN management remains fragmented, with limited integration of evidence-based pharmacologic and behavioral approaches. Remote BP monitoring (RBPM), pharmacist-led medication management via telehealth, and automated text reminders are each evidence-based approaches that improve HTN outcomes, but they have rarely been integrated into a bundled model tailored to HIV care. In 2024, the University of Alabama at Birmingham (UAB) conducted a pilot randomized controlled trial (RCT) testing this bundled approach among adults with uncontrolled BP at an Emergency-Department Transitional Care Clinic. The intervention demonstrated high reach (92% enrollment), high fidelity (80% visit completion, 85% measured BP ≥2 times/day), and preliminary clinical effectiveness (78% achieving BP <130/80 mmHg vs 50% in usual care). Building on these data, we propose a fully powered, hybrid type 1 implementation-effectiveness RCT across two Southern Center for AIDS Research Network of Integrated Clinical Systems (CNICS) clinics: the UAB 1917 HIV Clinic and the Vanderbilt Comprehensive Care Clinic. We will randomize 552 PWH with elevated BP to intervention or usual care. The bundled intervention includes RBPM, pharmacist-led telehealth visits with guideline-based medication titration, and automated text reminders integrated into HIV clinical workflows. Effectiveness will be assessed through BP control and patient-reported outcomes at 12- and 24-weeks. Implementation will be evaluated through fidelity, feasibility, and acceptability metrics using validated measures and qualitative interviews. Sustainability will be assessed through semi-structured interviews with providers, pharmacists, payers, and CNICS site leaders guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to inform future network-wide expansion. We hypothesize that the bundled intervention will improve BP control by ≥10% compared with usual care, enhance patient-reported outcomes, be delivered with high fidelity and acceptability, and yield strategies for long-term sustainment and scalability. This pragmatic trial targets a population with a high burden of uncontrolled HTN in an integrated HIV care setting and addresses a critical gap in cardiometabolic management among PWH. Findings will generate essential evidence on the effectiveness, implementation, and scalability of a pharmacist-led, telehealth- enabled HTN management model embedded within CNICS HIV clinics, directly informing strategies to strengthen chronic disease care and advancing NIH’s mission to prevent and treat CVD among PWH.
